Cost-Effectiveness of In-Bed Cycling and Routine Physiotherapy for Patients Receiving Mechanical Ventilation
Notice bibliographique
Résumé
Importance: The cost-effectiveness of adding early in-bed cycling to usual physiotherapy among adults receiving mechanical ventilation in the intensive care unit (ICU) compared with usual physiotherapy alone is unknown. Objective: To evaluate the cost-effectiveness of in-bed cycling plus usual physiotherapy compared with usual therapy alone in the Critical Care Cycling to Improve Lower Extremity Strength (CYCLE) randomized clinical trial. Design, Setting, and Participants: This trial-based economic evaluation with a 90-day time horizon compared early cycling plus usual physiotherapy vs usual physiotherapy alone from a societal perspective. Adult ICU patients (aged ≥18 years) receiving mechanical ventilation were recruited from 16 ICUs in Canada, the US, and Australia. Enrollment occurred from November 1, 2016, to May 30, 2023, with the last follow-up on August 3, 2023. Interventions: Intervention group participants were offered 30 minutes per day of cycling in addition to usual physiotherapy on weekdays, starting within the first 4 days of mechanical ventilation. Cycling continued until the patient could march on the spot for 2 consecutive days, ICU discharge, or for 28 days, whichever occurred first. Usual care participants were offered individualized physiotherapy according to local practices and patient alertness. Main Outcomes and Measures: Differences in costs (in 2024 Canadian dollars [CA$]) and quality-adjusted life-years (QALYs) between the groups were calculated. In the absence of dominance (ie, 1 strategy is associated with higher costs and fewer QALYs), the results were reported in terms of incremental cost per QALY gained. Results: The CYCLE trial recruited 360 patients (mean [SD] age, 61.5 [15.6] years; 205 male [56.9%]). The estimated per-patient cost associated with providing early in-bed cycling (CA$321) represented 0.5% of the index hospitalization costs (CA$66 554). The per-patient differences in 90-day costs (CA$5841; 95% CI, -CA$7666 to CA$18 797) and QALYs (-0.0009; 95% CI, -0.0185 to 0.0182) between cycling plus usual physiotherapy vs usual physiotherapy alone were not statistically different from 0. The probability of cycling plus usual physiotherapy to be cost-effective was 0.19 at a willingness-to-pay threshold of $50 000 per QALY gained. Conclusions and Relevance: In this trial-based economic evaluation, the differences in costs and QALYs between adding early in-bed cycling to usual physiotherapy and usual physiotherapy alone for adults receiving mechanical ventilation were not significantly different from 0. These results highlight the need for additional cost-effectiveness studies considering the full body of evidence regarding in-bed cycling for critically ill patients.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».